Complications in m injections. Possible complications of intramuscular injections. Failure to comply with asepsis rules

The palm of the hand with the thumb abducted as far as possible is applied to the thigh so that the end thumb reached the anterior-inferior axis of the ilium, and its base touched the upper edge of the greater trochanter (movement in hip joint helps identify the greater trochanter).

The index finger should be in line with the skewer. The injection site corresponds to the head of the second metacarpal bone. In other words, best place for intramuscular injection, it is located in the middle of the line (parallel to the longitudinal axis of the body) connecting the upper edge of the ilium and the greater trochanter. Intramuscular injections around this point can be done within a radius of 2-2.5 cm. You should be careful about injections near the trochanter for fear of getting into the periarticular area rich in blood vessels. By deviating from the indicated point towards the back, you can get into the subcutaneous fatty tissue of the supragluteal region.

Preparation of the syringe, treatment of the nurse’s hands and the patient’s skin is carried out according to general rules asepsis. The nurse should wash their hands with soap and a brush under running water. hot water immediately before assembling the syringe or processed using another method used in the clinic (pervomur solution, iodopirol). Do not touch foreign objects with clean hands. Therefore, the site and means for injection must be prepared in advance. It is necessary to make any injections only with sterile gloves (according to order No. 408 on the prevention of the spread of viral hepatitis in the country).

Most often, antibiotics, magnesium sulfate, and serums are administered intramuscularly.

Antibiotics are produced in special bottles in the form of crystalline powder. Before use, it is dissolved in a sterile isotonic solution sodium chloride, double distilled water or 0.5% novocaine solution. Some antibiotics are already available in diluted form. Having collected the medicinal substance into a syringe, they begin to treat the patient’s skin with 70% ethyl alcohol.

Holding the syringe with the needle perpendicular to the skin above the injection site, make an injection and enter the muscle through the subcutaneous fat. During the injection, press down the skin around the puncture site with your left hand.

Techniques for administering medicinal substances:

the skin over the puncture site is stretched with the index and thumb left hand, and insert the syringe with the right hand;

the skin above the puncture site is gathered into a loose fold with the index and thumb of the left hand;

the syringe is held in this way - the second finger holds the piston, the fifth finger holds the needle coupling, and the remaining fingers hold the cylinder;

the position of the syringe should be perpendicular to the surface of the patient’s body;

with severe asthenia of the patient, an injection is made into the gluteal region, as in the thigh - the syringe is held like a pen, at an angle, so as not to damage the periosteum;

with a decisive movement, insert a needle with a syringe into the middle of the skin fold to a depth of 7-8 cm, leaving 1 cm above the coupling, since this is where the needle most often breaks; you cannot make too sudden movements and you cannot slow down the movement of the syringe with the needle, it should seem to “fall under the weight of its weight”;

injection of a needle only without a syringe is currently not used due to the many side effects and complications; such an injection was called the “clap method”: the needle was clamped between the second and third fingers of the right hand, and after insertion the syringe was quickly attached;

after inserting a needle into a muscle using any of the above methods (except for the initial insertion of a needle without a syringe), it is necessary to pull the piston towards you, make sure that the needle is not in a blood vessel (blood does not appear in the syringe), only then press the piston, gradually displacing solution until complete. After blood appears in the syringe, it is necessary to remove the needle and insert it into another place; remove the needle with a quick movement, pressing a cotton swab soaked in alcohol to the skin.

Initial insertion of a needle without a syringe is possible only in limited cases: the penetration of even small amounts of some medications (a solution of quinacrine) into the subcutaneous fat tissue causes severe irritation and often the formation of an abscess. Such medications should be administered in two stages: first, insert a dry, sterile needle into the muscle, tested for air permeability and not in contact with the drug before administration; then quickly attach the syringe and slowly inject the solution.

Complications

All complications resulting from intramuscular injections can be divided into 3 groups: mechanical, chemical and infectious.

A needle fracture during intramuscular injections occurs for the same reasons as during subcutaneous injections, but most often due to sudden muscle contraction during rough insertion of a blunt, defective needle.

Damage to nerve trunks ( sciatic nerve and other nerve branches) can be mechanical (injection needle when choosing the wrong place for injection), chemical (irritant effect of the drug, the depot of which is located near the nerve), vascular (due to blockage of the vessels supplying the nerve).

Damage to the nerve leads to neuritis, impaired sensitivity and movement in the limbs (paralysis, paresis).

Drug embolism with intramuscular injections is more common than with subcutaneous injections, since the vascular network in the muscles is more developed.

The most common among all types of complications are infectious (purulent) complications. Infiltrate, abscess are the brightest examples insufficient sterilization of the syringe and needles, insufficient cleaning of the surface of the ampoule before opening it, insufficient thorough cleaning of the nurse’s hands and the patient’s skin. There is no clear division of existing complications into mechanical, chemical and infectious, because there is always a moment when purely mechanical damage an infection may develop. An example of this is bruising resulting from gross injury with a blunt needle, which contributes to the development of suppuration.

With any type of intervention (subcutaneous, intramuscular, intravenous manipulation) without observing the rules of asepsis, there is a risk of transmission of such infectious diseases, like viral hepatitis, AIDS, etc., transmitted by blood.

You should remember the possibility of allergic reactions to the administration of a number of medications, up to the development of anaphylactic shock. Some medications should be administered only using the non-recurring (fractional) method.

Greatest danger represent drugs containing foreign protein (serum, immunoglobulin, albumin, blood plasma) and chemotherapeutic drugs (antibiotics).

If it is necessary to introduce one or another medicinal substance persons with a certain allergic mood are desensitized with antihistamines.

"Nurse's Directory" 2004, "Eksmo"

Complications may occur after any type of injection. The cause may be an incorrectly placed injection, poor hygiene during the procedure, or individual intolerance of the body. How to prevent complications after an injection? We will describe in detail what should be done at the first signs of injection complications in this article.

Complications with intramuscular injection

Complications with an intramuscular injection are more common than after a subcutaneous injection. The main complications include the following:

Abscess is a collection of pus in muscle tissue.
Infiltration - formation of compaction.
Redness, burning and other skin reactions.

The patient may develop a fever and general malaise. These may be signs of sepsis.

Stand out possible reasons for which complications arise after intramuscular injection:

The injection was made with a needle that was too short and the medication got under the skin and not intramuscularly.
The syringe or hands were not sterile enough, and bacteria entered the muscle.
The medicine was administered too quickly.
The medicine was made for a long time. As a result, a compaction appeared.
An allergic reaction of the body to a medication.

If a patient develops a lump after an intramuscular injection and the muscle hurts, you can try to alleviate the condition with ointments: Traxevasin, Traxerutin. At night, you can make a mesh with iodine or lotions with alcohol. ethnoscience recommends applying cakes made from honey and flour. To do this, honey is mixed with flour and a small cake is made. It is applied to the sore muscle and covered with film overnight.

An abscess can be cured using compresses with ointments: Vishnevsky or Heparin. But if there is an increase in temperature, it is better to consult a doctor. The fact is that an abscess can rupture inside the muscle and infection will occur. IN difficult cases may be needed surgical intervention.

If redness appears, you should consult an allergist or your doctor. The drug that is being administered most likely causes an allergy. It is necessary to change the medication to a less allergenic analogue.

Complications after a subcutaneous injection

Subcutaneous injection rarely causes complications. The fact is that mistakes are made less often during subcutaneous administration.

Possible complications include:

Allergic reactions at the injection site.
Formation of ulcers.
Air embolism is when air gets under the skin.
Formation of a hematoma at the site of needle insertion.
Lipodystrophy - the formation of pits under skin. Associated with the breakdown of fat due to frequent administration of a drug, for example, insulin.

Complications may have the following causes:

Misadministration of the wrong drug.
Air getting into the syringe along with the medicine.
Getting bacteria under the skin.
Using a blunt needle to prick.

If any of the complications arise, you need to contact a specialist. You may need surgical intervention or a change in medication.

When an abscess forms, you should not lubricate the lesion with iodine or brilliant green. It will be difficult for the doctor to examine the sore spot and determine the cause.

Complications after an injection into a vein

Intravenous injections are given in the hospital; they are rarely given at home. Complications with a well-placed intravenous injection occur sporadically.

Possible ones include:

Thrombophlebitis - damage to the vessel and inflammation of the vein, the formation of a blood clot.
Oil embolism - an oil-based composition was accidentally injected into a vein. Together with the blood, it enters the vessels of the lungs and the patient suffocates. In 90% it ends in death.

First aid can only be provided within the walls of the hospital, since mistakes when injecting into a vein are dangerous.

It's easier to prevent than to cure

You can prevent complications after intramuscular or subcutaneous injection in simple ways:

Do intramuscular injection You can only use a needle from a syringe for 5 or more cubes. The needle from a two-cc syringe is suitable for subcutaneous administration of the drug.
All injections are made with a sharp needle. If it is necessary to draw the drug into a syringe from a vial with a rubber cap, then the puncture is carried out with a separate needle.
Before injection, shake the syringe and release any air bubbles. Release some of the medication through the needle; there may also be air there.
The procedure is performed only under sterile conditions. The needle insertion site is pre-treated with spit.
For injections, it is better to use disposable syringes.
Before any injections, the doctor must do a test for the prescribed drug.

Among the most terrible complications are infections with HIV, hepatitis or sepsis. The video explains which medications and where to administer them correctly to avoid mistakes.

Any medical procedures require strict adherence to instructions. Even something as simple as an intramuscular injection can lead to dangerous complications which are often fatal. One of these complications is medication.

Features of the disease

Drug embolism is the blockage of blood vessels with medicinal solutions. The condition is dangerous because it can lead to death due to untimely diagnosis and a drop of oil getting into the pulmonary arteries.

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Drug embolism (photo)

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Classification

There is no exact classification of drug embolism, however, it can be conditionally distributed according to the location of the vessel blockage. The fact is that the oil, entering the bloodstream, can be transferred to other organs, for example:

liver;

And very rarely to other organs. Most often it is localized at the injection site.

Causes

The main and only cause of drug embolism is a violation of the technique of subcutaneous and intramuscular injections. If the needle enters a vessel, the oil solution can clog the artery, leading to disruption of the blood supply to the area and necrosis. Often this situation occurs when the injection is given into the infiltrate formed in the area of the previous injection. Risk factors for oil embolism include:

introduction of unheated solution;
injection too quickly;
violation of asepsis rules;

Note! It is important to understand that oil solutions are not administered intravenously. IN medical practice such excesses are excluded, but in living conditions some patients may misuse medications, which also leads to pathology.

Symptoms

Symptoms largely depend on the location of the blockage of the vessel. If an oil drop enters the pulmonary vessels through the bloodstream, the patient experiences pronounced signs like:

attack of suffocation;
cough;
cyanosis of the upper half of the body;
strong feeling of tightness in the chest;

Most often on early stages the disease may manifest itself mildly: pain at the injection site. And only after the development of necrosis do they appear acute signs such as edema, cyanosis of the skin, increased local and general temperatures.

Diagnostics

Diagnosis of embolism is complicated by the fact that it is not always possible to associate symptoms with this form of embolism, therefore differential diagnosis carried out with them (PE, and others), as well as with medicinal idiosyncrasy. As a primary diagnosis, standard methods of collecting anamnesis and examination, especially of injection sites, are used, which allows us to suggest the cause of the embolism.

To confirm the diagnosis, the patient must undergo additional tests, for example:

General blood and urine tests that help identify accompanying pathologies and possible causes of the patient's condition.
Biochemical blood analysis aimed at identifying additional risk factors.
X-ray and ultrasound to detect the presence of blockage of blood vessels.

Depending on the severity of the symptoms of the disease (drug embolism), other studies may be prescribed, for example, ECG or MRI.

Treatment

Treatment of drug-induced oil embolism is aimed at eliminating blockage of blood vessels and restoring normal blood circulation in the tissues. For this purpose, drug therapy is used, and in rare cases, surgery is prescribed.

It is strictly forbidden to treat oil embolism using folk remedies, since this is guaranteed to lead to death. Folk remedies can be used after conservative treatment to restore the body.

First aid for drug embolism

First aid is necessary for patients with acute condition, for example, when breathing stops or faints. First you need to call ambulance, and before her arrival:

lay the patient on a flat surface;
free him from tight clothes;
carry out resuscitation measures to restore breathing until doctors arrive;

Subsequent care consists of carefully transporting the patient to the hospital. A stretcher is used for this.

Therapeutic method

During therapeutic treatment the patient is prescribed rest and a strict diet. If a patient is admitted to the hospital with an acute condition, oxygen therapy is administered through nasal catheters.

If oxygen therapy is ineffective, respiratory therapy is carried out to maintain PaO2 above 70 mmHg. Art. and SpO2 at the level of 90-98%.

Medication method

Drug treatment depends on the symptoms and location of the blocked vessel. The following drugs are mainly prescribed:

Analgesics to reduce fever.
Antibiotics wide range to prevent infection.
Corticosteroids.
Sedative therapy.

Other medications, such as diuretics, are often used.

Operation

The operation is indicated in advanced stages, when by medication the blockage cannot be removed.

Surgical intervention may also be necessary to eliminate the consequences of the pathology. Thus, in case of tissue necrosis, surgical removal is indicated.

Prevention

The main prevention of drug-induced oil embolism is the proper selection of areas for subcutaneous and muscle injections, as well as compliance with the instructions for the drugs (it is forbidden to inject oil solutions into a vein). It is better to administer drugs subcutaneously in:

outer surface of the shoulder;
lower part of the armpit area;
lateral surface abdominal wall;
anterior outer region of the thigh;
subscapular space;

In these places, a fold of skin is first grasped, and only then an injection is made. It is better to give an injection intramuscularly in the area of the gluteal muscles, you can also in the muscle of the anterior femoral surface or deltoid. It is not recommended to inject yourself because it is so difficult to control the injection process. It is better to take the help of medical personnel or loved ones with at least minimal knowledge about injections.

It is also worth observing the minimum rules:

disinfect the injection area and instruments;
use a needle of at least 6 cm;

It is advisable to carry out injections in two stages. First, insert a needle into the injection area that is not in contact with the solution, and then connect a syringe with medicine to it and then inject.

Complications

Drug embolism is a complication of injections, so it is inappropriate to say that it leads to complications. In the absence of proper treatment, embolism leads to serious disturbances in blood supply, which affects all organs, internal bleeding, extensive tissue necrosis can develop, and the risk increases.

Read on to learn about the prognosis and possible outcome of drug-induced embolism.

Forecast

The prognosis of drug-induced embolism is assessed as unfavorable, although cases fatal outcome, compared to other forms of pathology, are rare. In hospital treatment most patients can be rehabilitated without subsequent disability.

A specialist will tell you how to give injections yourself so as not to fall victim to an oil embolism in the video below:

Incorrect injection technique

needle breakage, air or drug embolism, allergic reactions, tissue necrosis, hematoma

Infiltrate- the most common complication after subcutaneous and intramuscular injections. Most often, infiltration occurs if: a) the injection is performed with a blunt needle; b) for intramuscular injection, a short needle intended for intradermal or subcutaneous injections is used. Inaccurate choice of injection site, frequent injections into the same place, violation of aseptic rules are also the cause of infiltrates.

Abscess — purulent inflammation soft tissues with the formation of a cavity filled with pus. The reasons for the formation of abscesses are the same as for infiltrates. In this case, infection of soft tissues occurs as a result of violation of asepsis rules.

Needle breakage during injection is possible when using old, worn needles, as well as when there is a sharp contraction of the buttock muscles during an intramuscular injection, if a preliminary conversation was not held with the patient before the injection or the injection was given to the patient in a standing position.

Drug embolism can occur when injecting oil solutions subcutaneously or intramuscularly (oil solutions are not injected intravenously!) and the needle gets into the vessel. Oil, once in the artery, will occlude it, and this will lead to disruption of the nutrition of the surrounding tissues and their necrosis. Signs of necrosis: increasing pain in the injection area, swelling, redness or red-bluish discoloration of the skin, increased local and general temperature. If the oil ends up in a vein, it will enter the pulmonary vessels through the bloodstream. Symptoms of pulmonary embolism: a sudden attack of suffocation, cough, blue discoloration of the upper half of the body (cyanosis), a feeling of tightness in the chest.

Air embolism with intravenous injections is the same dangerous complication as oil. The signs of embolism are the same, but they appear very quickly, within a minute.

Damage to nerve trunks can occur with intramuscular and intravenous injections, either mechanically (if the injection site is incorrectly chosen) or chemically when the depot medicine appears near the nerve, as well as when the vessel supplying the nerve is blocked. The severity of the complication can vary - from neuritis to limb paralysis.

Thrombophlebitis- inflammation of a vein with the formation of a blood clot in it - observed with frequent venipunctures of the same vein, or when using blunt needles. Signs of thrombophlebitis are pain, skin hyperemia and the formation of infiltrate along the vein. The temperature may be low-grade.

Necrosis tissue can develop due to unsuccessful vein puncture and erroneous injection of a significant amount of irritating agent under the skin. Ingress of drugs along the course of venipuncture is possible due to: piercing the vein ‘through and through’; failure to enter the vein initially. Most often this happens due to inept intravenous administration 10% calcium chloride solution. If the solution does get under the skin, you should immediately apply a tourniquet above the injection site, then inject a 0.9% sodium chloride solution into the injection site and around it, a total of 50-80 ml (it will reduce the concentration of the drug).

Hematoma can also occur during inept venipuncture: a purple spot appears under the skin, because the needle pierced both walls of the vein and blood penetrated into the tissue. In this case, the vein puncture should be stopped and pressed for several minutes with cotton wool and alcohol. In this case, the necessary intravenous injection is given into another vein, and a local warming compress is placed on the area of the hematoma.

Allergic reactions to the administration of a particular drug by injection can occur in the form of urticaria, acute runny nose, acute conjunctivitis, Quincke's edema, often occurring after 20-30 minutes. after administration of the drug. The most formidable form allergic reaction- anaphylactic shock.

Anaphylactic shock develops within a few seconds or minutes from the moment of administration medicinal product. The faster the shock develops, the worse the prognosis.

The main symptoms of anaphylactic shock: a feeling of heat in the body, a feeling of tightness in the chest, suffocation, dizziness, headache, anxiety, severe weakness, decrease blood pressure, violations heart rate. In severe cases, these signs are accompanied by symptoms of collapse, and death can occur a few minutes after the first symptoms of anaphylactic shock appear. Therapeutic measures in case of anaphylactic shock, they should be carried out immediately upon detection of a feeling of heat in the body.

Long-term complications that occur two to four months after the injection are viral hepatitis B, D, C, as well as HIV infection.

Parenteral hepatitis viruses are found in significant concentrations in blood and semen; are found in lower concentrations in saliva, urine, bile and other secretions, both in patients suffering from hepatitis and in healthy virus carriers. The method of transmission of the virus can be blood transfusions and blood substitutes, therapeutic and diagnostic procedures in which the skin and mucous membranes are damaged.

To the group greatest risk hepatitis B virus infection includes persons performing injections.

According to V.P. Ventsela (1990), the first method of transmission of viral hepatitis B is needle pricks or injuries with sharp instruments (88%). Moreover, these cases are usually caused by careless attitude towards used needles and their reuse. Transmission of the pathogen can also occur through the hands of the person performing the manipulation and having bleeding warts and other hand diseases accompanied by exudative manifestations.

The high probability of infection is due to:

incubation period

a large number asymptomatic carriers.

Currently available specific prevention viral hepatitis B, which is carried out by vaccination.

In order to protect yourself from HIV infection, every patient should be considered as potentially infected with HIV, since even negative result testing the patient's blood serum for the presence of antibodies to HIV may be false negative. This is explained by the fact that there is an asymptomatic period from 3 weeks to 6 months, during which antibodies in the blood serum of an HIV-infected person are not detected.

Thrombophlebitis on the arm after injection

Hello, dear doctor. After anesthesia, a blood clot formed on my arm. I saw a doctor and they said the danger had passed and everything was fine. Tell me please, is there a way to treat them? And if not, can I train in the gym and put a lot of stress on my arm? Thank you in advance.

Lusine, Moscow, Russia, 33 years old

Sister

Complications after intramuscular injections

29.05.2012 |

The nurse must clearly understand what they may be and how to avoid them. If complications arise, the nurse must know the algorithm of medical care for the patient.

So, complications after intramuscular injections may be next.

Needle breakage

Not often, but it does happen. Cause - strong muscle contraction due to fear of the procedure, unexpected start of injection, incorrect psychological preparation patient.

Help: keeping calm, reassure the patient, assure him that everything will be fine. With the 2nd and 2nd fingers of your left hand, press down the tissue on both sides of the broken needle, squeezing it out in this way. Right hand take tweezers, carefully grab the tip of the fragment and remove it. The action is repeated several times. If attempts are unsuccessful, urgently call a doctor through an intermediary, remaining with the patient and reassuring him. In the future, follow all the doctor’s instructions.

Damage to the periosteum

Can occur when giving an intramuscular injection with a needle that is too long in a thin patient. Help: referral to a surgeon and implementation of his instructions. Prevention: correlate the length of the needle with the size of the patient’s subcutaneous fat layer at the site of the intended injection.

Traumatization of nerve trunks

Such complications after intramuscular injections may occur when the needle is inserted not into the upper-outer quadrant of the buttock, but, for example, into the lower-outer quadrant. Nerve trunks can also be damaged when the drug acts directly on the nerve tissue. This happens if the drug is injected near the location of the nerve.

Help: referral to a doctor and explanation to the doctor of all the circumstances surrounding the injection.

Infiltrates

Causes: rapid administration of the drug, low temperature of the administered medicinal substance, insufficient needle length, injections into places located next to a recently made injection or with an old infiltrate.

Help . applying a semi-alcohol compress or the same with the addition of a 25% solution of magnesium sulfate, informing the attending physician.

Abscesses

Causes: non-compliance with the rules of asepsis and antisepsis, injections into infiltrates, intramuscular injections using a short needle.

Help: urgent referral to a surgeon.

Hematomas

Causes: damage blood vessels needle.

Help: referral to a doctor and fulfillment of his prescriptions.

Emboli

Oil and suspension embolisms occur when a needle enters the lumen of a blood vessel with subsequent administration of a drug. If there is insufficient air displacement from the syringe, there is a risk of an air embolism if the entire contents of the syringe are injected into the blood vessel where the needle entered.

Help: placing the patient in a lying position on his side with the head end raised, immediately calling a doctor through an intermediary.

Prevention: complete displacement of air from the lumen of the syringe, “pulling back” the piston when the needle is inserted with the intention of introducing oil or suspension solutions.

Thrombophlebitis and necrosis

Such complications after intramuscular injections rare, but they do happen. Thrombophlebitis occurs when blood vessels are damaged, often multiple times, followed by necrotization of soft tissues.

Help: when the patient complains about severe pain and the presence of hematomas, immediate consultation with a surgeon.

Infection with HIV, parenteral hepatitis

Causes: gross violation of the rules of asepsis and antisepsis when administering intramuscular injections, including hand washing, pre-sterilization cleaning and sterilization of instruments.

Prevention: strict adherence to all existing regulations and sanitary standards during invasive procedures.

Allergic reactions

When administering any drug, the patient may experience an allergic reaction ranging from urticaria to anaphylactic shock . The treatment room should be equipped with an anti-shock first aid kit and instruments to assist in respiratory arrest.

Knowing the possible complications after IM injections, nurse must make every possible effort to prevent them. And if any complication arises, be ready to take the necessary actions on your part.

The following complications are possible with intramuscular injections:

The needle enters a blood vessel, which can lead to to embolism, if oil solutions or suspensions are introduced, which should not enter directly into the bloodstream. When using such drugs, after inserting the needle into the muscle, pull the piston back and make sure that there is no blood in the syringe.

· Infiltrates - painful lumps in the thickness of the muscle tissue at the injection site. They may occur on the second or third day after the injection. The reasons for their occurrence may be either non-compliance with the rules of asepsis (non-sterile syringe, poorly treated injection site), or repeated administration of drugs to the same place, or increased sensitivity human tissues to the administered drug (typical for oil solutions and some antibiotics).

· Abscess- manifested by hyperemia and soreness of the skin over the infiltrate, elevated temperature bodies. Requires urgent surgical treatment and treatment with antibiotics.

· Allergic reactions to the administered drug. To avoid these complications, before administering the drug, an anamnesis is collected to determine the presence of allergic reactions to any substances. For any manifestation of an allergic reaction (regardless of the method of previous administration), it is advisable to discontinue the drug, since repeated administration of this drug can lead to anaphylactic shock.

Subcutaneous injections

Used, for example, when administering insulin.

The subcutaneous fat layer has a dense vascular network, so medicinal substances administered subcutaneously have an effect faster compared to oral administration - they bypass gastrointestinal tract, entering directly into the bloodstream. Subcutaneous injections are made with a needle of the smallest diameter and up to 2 ml of medications are injected, which are quickly absorbed into the loose subcutaneous tissue without causing any harmful effects on it.

The most convenient sites for subcutaneous injection are:

· outside surface shoulder;

· subscapular space;

· anterior outer surface of the thigh;

· side surface abdominal wall;

· lower part of the axillary region.

In these places, the skin is easily caught in the fold and the risk of damage to blood vessels, nerves and periosteum is minimal.

· in places with edematous subcutaneous fat;

· in compactions from poorly absorbed previous injections.

The skin above the injection site is folded, the needle is inserted into the skin at an angle of 45°, then the drug solution is smoothly injected into the subcutaneous fat.

Intravenous injections

Intravenous injections involve the administration of a drug directly into the bloodstream. Most important rule At the same time, there is strict adherence to the rules of asepsis (washing and treating hands, the patient’s skin, etc.).

Features of the structure of veins

For intravenous injections, the veins of the cubital fossa are most often used, since they have a large diameter, lie superficially and move relatively little, and also superficial veins hands, forearms, rarely veins lower limbs. Theoretically, intravenous injection can be made into any of the veins of the human body

Saphenous veins upper limb - radial and ulnar saphenous veins. Both of these veins, connecting over the entire surface of the upper limb, form many connections, the largest of which is the middle vein of the elbow, most often used for punctures.

Depending on how clearly the vein is visible under the skin and palpated (palpable), three types of veins are distinguished:

· Well contoured vein. The vein is clearly visible, clearly protrudes above the skin, and is voluminous. The side and front walls are clearly visible. During palpation, almost the entire circumference of the vein can be felt, with the exception of the inner wall.

· Poorly contoured vein. Only the anterior wall of the vessel is very clearly visible and palpated; the vein does not protrude above the skin.

· Uncontoured vein. The vein is not visible and is very poorly palpated, or the vein is not visible or palpable at all.

According to the degree of fixation of the vein in the subcutaneous tissue, the following options are distinguished:

· Fixed vein- the vein moves along the plane slightly; it is almost impossible to move it to a distance the width of the vessel.

· Sliding vein- the vein easily moves in the subcutaneous tissue along the plane; it can be moved to a distance greater than its diameter. In this case, the lower wall of such a vein, as a rule, is not fixed.

Based on the severity of the wall, the following types can be distinguished:

· Thick-walled vein- the vein is thick, dense.

· Thin-walled vein- a vein with a thin, easily vulnerable wall.

Using all of the listed anatomical parameters, the following clinical options are determined:

1. well contoured fixed thick-walled vein - such a vein is found in 35% of cases;

2. well contoured sliding thick-walled vein - occurs in 14% of cases;

3. weakly contoured, fixed thick-walled vein - occurs in 21% of cases;

4. weakly contoured sliding vein - occurs in 12% of cases;

5. uncontoured fixed vein - occurs in 18% of cases.

The veins of the first two clinical options are most suitable for puncture. Good contours and a thick wall make it quite easy to puncture the vein.

The veins of the third and fourth options are less convenient, for the puncture of which a thin needle is most suitable. You just need to remember that when puncturing a “sliding” vein, it must be fixed with the finger of your free hand.

The veins of the fifth option are the most unfavorable for puncture. When working with such a vein, preliminary palpation (palpation) is used; blind puncture is not recommended.

Post-injection complications

Infiltrate- the most common complication after subcutaneous and intramuscular injections. Most often, infiltration occurs if:

a) the injection was performed with a blunt needle;

b) for intramuscular injection, a short needle intended for intradermal or subcutaneous injections is used. Inaccurate choice of injection site, frequent injections into the same place, violation of aseptic rules are also the cause of infiltrates.

Abscess- purulent inflammation of soft tissues with the formation of a cavity filled with pus. The reasons for the formation of abscesses are the same as for infiltrates. In this case, infection of soft tissues occurs as a result of violation of asepsis rules.

Air embolism with intravenous injections is the same dangerous complication as oil. The signs of embolism are the same, but they appear very quickly, within a minute.
Damage to nerve trunks can occur with intramuscular and intravenous injections, either mechanically (if the injection site is chosen incorrectly), or chemically, when the drug depot is located next to the nerve, as well as when the vessel supplying the nerve is blocked. The severity of the complication can vary - from neuritis to limb paralysis.
Thrombophlebitis- inflammation of a vein with the formation of a blood clot in it - observed with frequent venipunctures of the same vein, or when using blunt needles. Signs of thrombophlebitis are pain, skin hyperemia and the formation of infiltrate along the vein. The temperature may be low-grade.
Necrosis tissue can develop due to unsuccessful vein puncture and erroneous injection of a significant amount of irritating agent under the skin. Ingress of drugs along the course of venipuncture is possible due to: piercing the vein “through and through”; failure to enter the vein initially. Most often this happens with inept intravenous administration of a 10% calcium chloride solution. If the solution does get under the skin, you should immediately apply a tourniquet above the injection site, then inject a 0.9% sodium chloride solution into the injection site and around it, a total of 50-80 ml (it will reduce the concentration of the drug).

Allergic reactions to the administration of a particular drug by injection can occur in the form of urticaria, acute runny nose, acute conjunctivitis, Quincke's edema, often occurring after 20-30 minutes. after administration of the drug. The most severe form of an allergic reaction is anaphylactic shock.

Anaphylactic shock develops within a few seconds or minutes from the moment the drug is administered. The faster the shock develops, the worse the prognosis.

The main symptoms of anaphylactic shock: a feeling of heat in the body, a feeling of tightness in the chest, suffocation, dizziness, headache, anxiety, severe weakness, decreased blood pressure, heart rhythm disturbances. In severe cases, these signs are accompanied by symptoms of collapse, and death can occur a few minutes after the first symptoms of anaphylactic shock appear. Treatment for anaphylactic shock should be carried out immediately upon detection of a feeling of heat in the body.

Long-term complications, which occur two to four months after the injection, are viral hepatitis B, D, C, as well as HIV infection.

People most at risk of contracting the hepatitis B virus include injectors.

According to V.P. Venzela (1990), the first place among the methods of transmission of viral hepatitis B is needle pricks or injuries with sharp instruments (88%). Moreover, these cases are usually caused by careless attitude towards used needles and their reuse. Transmission of the pathogen can also occur through the hands of the person performing the manipulation and having bleeding warts and other hand diseases accompanied by exudative manifestations.

The high probability of infection is due to:

high resistance of the virus in the external environment;
the duration of the incubation period (six months or more);
a large number of asymptomatic carriers.
Currently, there is specific prevention of viral hepatitis B, which is carried out through vaccination.
Both hepatitis B and HIV infection, which ultimately leads to AIDS (acquired immunodeficiency syndrome), are life-threatening diseases.
Unfortunately, today the expected mortality rate for HIV-infected people is 100%. Almost all cases of infection occur as a result of careless, negligent actions during medical procedures: needle pricks, cuts from fragments of test tubes and syringes, contact with damaged skin areas that are not protected by gloves.
In order to protect yourself from HIV infection, each patient should be considered as a potential HIV-infected person, since even a negative result of testing the patient's blood serum for the presence of antibodies to HIV may be a false negative. This is because there is an asymptomatic period of 3 weeks to 6 months during which HIV serum antibodies

· Body areas for intramuscular injections.

· Intramuscular injection: inserting a needle into a muscle.

· Body areas for subcutaneous injections.

One of the most common anatomical features vein is the so-called fragility. Visually and palpably, fragile veins are no different from ordinary ones. Their puncture, as a rule, also does not cause difficulty, but at the puncture site it is very quickly a hematoma appears, which increases, despite the fact that all control techniques confirm that the needle has entered the vein correctly. It is believed that what is likely happening is that the needle is a wounding agent, and in some cases the puncture of the vein wall corresponds to the diameter of the needle, and in others, due to anatomical features, a rupture occurs along the course of the vein.

Violations in the technique of fixing the needle in the vein can also lead to complications. A loosely fixed needle causes additional trauma to the vessel. This complication occurs almost exclusively in elderly people. With this pathology, the administration of the drug into this vein is stopped, another vein is punctured and infusion is carried out, paying attention to fixing the needle in the vessel. A tight bandage is applied to the area of the hematoma.

A fairly common complication is the infusion of infusion solution. into the subcutaneous tissue. Most often, after puncture of a vein, the needle is not fixed firmly enough in the elbow; when the patient moves his hand, the needle comes out of the vein and the solution enters under the skin. It is recommended to fix the needle in the elbow bend at at least two points, and in restless patients, fix the vein throughout the limb, excluding the joint area.

Another reason for fluid entering under the skin is through puncture veins, this often happens when using disposable needles, sharper than reusable ones, in this case the solution enters partially into the vein and partially under the skin.

In case of violation of the central and peripheral circulation the veins collapse. Puncture of such a vein is extremely difficult. In this case, the patient is asked to clench and unclench his fingers more vigorously and at the same time pat the skin, looking through the vein in the puncture area. As a rule, this technique more or less helps with puncture of a collapsed vein. Primary training of medical staff on such veins is unacceptable.

Acute stomach

Acute abdomen is a series of acute surgical diseases of organs abdominal cavity threatening the development of peritonitis or already leading to it, and are also complicated by intraperitoneal bleeding.

The concept is collective, but has great practical significance, since it directs the doctor to urgent hospitalization of the patient and surgery to prevent the development of peritonitis, fights it or ends with death of blood loss. The severity and strength of symptoms does not determine the diagnosis acute abdomen. Any attempts at self-medication can only lead to a tragic outcome.